1225505977 NPI number — SAINT FRANCIS PHARMACY INC

Table of content: MRS. MICHELLE CONSTANCE WALKER M.A., C.A.S. (NPI 1598166845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225505977 NPI number — SAINT FRANCIS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT FRANCIS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY PHARMACY AT ST. FRANCIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225505977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 HAMILTON AVE STE B-G21&23
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08629-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-668-4809
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HAMILTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08629-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-668-4809
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VINDYALA
Authorized Official First Name:
DEEPTHI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-666-7318

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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